Shoulder
Implant Extraction Set
Elbow
Hand &
Wrist
Hip
Pelvis
Femur
Tibia &
Fibula
Foot &
Ankle
Implant Extraction Guide
Module One & Two
Contents
Precautions and Contraindications
3
Product Description
4
Screws
6
Condyle Screws6
Cannulated Screws
7
Damaged Screw Head
7
Broken Screws
8
Plates
9
Broken Cannulated Screws
10
Lag Screw
11
Intramedullary Nails
13
Broken Intramedullary Nails
14
This publication sets forth detailed recommended procedures for using
Stryker devices and instruments. It offers guidance that you should heed,
but, as with any such technical guide, each surgeon must consider the
particular needs of each patient and make appropriate adjustments when
and as required. A workshop training is recommended prior to first surgery.
See package insert (L22000007) for a complete list of potential adverse
effects, contraindications, warnings and precautions. The surgeon must
discuss all relevant risks, including the finite lifetime of the device, with the
patient, when necessary.
2
Precautions and
Contraindications
Precautions
Stryker systems have not been evaluated for safety and compatibility in
MR environment and have not been tested for heating or migration in the
MR environment, unless specified otherwise in the product labeling.
Contraindications
Cold welded screws require cutting tools for metal to remove the screws.
The extraction set does not feature carbide drills or other cutting tools to
remove cold welded screws.
Stryker can only recommend use of the extractor instruments with its own
products. Application of the instruments to competitive products or to
Stryker products that have been altered may be possible but has not been
validated. Where competitive products are mentioned in this document this
is solely to indicate where application of the extractor instruments appears
possible due to similar design or dimensions, and Stryker does not guarantee
that the extractor instruments demonstrated herein will work in any cases
where competitive products are used, or in cases where Stryker products
have been altered. As a precaution, make sure to have other standard
instruments available in case the tolerances of the implants do not match
the tolerances of the extractor tool.
3
Product Description
Instrument
Stryker Systems
Teardrop Handle (AO-Medium)
Screwdriver Bit 2.5mm (conical)
Screwdriver Bit 3.5mm (conical)
Screwdriver Bit 4mm (conical)
Screwdriver Bit 5mm
Screwdriver Bit 6.3mm
Screwdriver Bit 8mm
Screwdriver Bit T 8 (Torx)
Screwdriver Bit T 15 (Torx)
Screwdriver Bit T 20 (Torx)
Screwdriver Bit T 25 (Torx)
Conical Extractor, male, left hand, small
(left hand driving) for diameter range 1–2.5mm
Conical Extractor, male, left hand, 2.5mm
(left hand driving, for damaged hex 2.5mm and
diameter range 2.3–4mm)
Conical Extractor, male, left hand, 3.5mm
(left hand driving, for damaged hex 3.5mm
and diameter range 3.3–4mm)
Conical Extractor, male, left hand, 4mm
(left hand driving, for damaged hex 4mm
and diameter range 3.8–4.4mm)
Conical Extractor, male, left hand, 5mm
(left hand driving, for damaged hex 5mm and
diameter range 4.8–5.4mm)
Crown drill 3
(bone drill for broken screws with diameter range ≤ 3mm
Crown drill 4
(bone drill for broken screws with diameter range ≤ 4mm
4
For AO-medium bits:
- Screwdriver bits
- Crown drills (Trephines)
- Conical extractors male/female
Screws:
- T2 humeral compression
- AsnisIII 4.0mm
- Numelock 4.5mm
- ISO 2.7mm
- ISO 3.5mm
- ISO 4.0mm
Screws:
- 4mm and 5mm locking screws (T2, S2, Gamma3, IC etc.)
- T2/S2 end caps
- T2/S2 femur/tibia compression screws
- TLN all screws
- 3.7mm and 4.6mm locking screws Grosse & Kempf
- AsnisIII 5.0mm
- Numelock 6.5mm
- ISO 4.5mm
- ISO 6.5mm
Screws:
- Set Screw for Gamma, Gamma3, Gamma Ti, Dyax-A, AP, AP-J;
- Proximal Plug for Gamma, Gamma Ti, Dyax, Dyax-A, AP, AP-J
Screws:
- 6.28mm locking screws
- AsnisIII 6.5mm and 8.0mm
- T2, S2, Recon lag screws
Screws:
- T2, S2 condyle screws
Screws:
- Grosse & Kempf, SCN condyle screws
- Gamma3 end cap
Screws:
- AxSOS 3.0mm
Screws:
- AxSOS 4.0mm
Screws:
- Alta 3.7mm locking screws
- AxSOS 5.0mm
Screws:
- Alta 5mm locking screws, lag screws and caps
Screws:
- AsnisIII 4.0mm
Screws:
- T2 Humerus compression
- AsnisIII 4.0mm
- ISO 2.7mm
- ISO 3.5mm
- ISO 4.0mm
Screws:
- 4mm and 5mm locking screws (T2, S2, Gamma3, IC etc.)
- T2, S2 end caps
- T2, S2 femur/tibia compression screws
- TLN all screws
- 3.7mm and 4.6mm locking screws Grosse & Kempf
- AsnisIII 5.0mm
- ISO 4.5mm
- ISO 6.5mm
Screws:
- Set Screw for Gamma, Gamma3, Gamma Ti, Dyax-A, AP, AP-J;
- Proximal Plug for Gamma, Gamma Ti, Dyax, Dyax-A, AP, AP-J
Screws:
- 6.28mm locking screws
- AsnisIII 6.5mm and 8.0mm
- T2, S2 Recon lag screws
n/a
n/a
Product Description
Instrument
Crown drill 5
(bone drill for broken screws with diameter range ≤ 5mm
Crown drill 6.5
(bone drill for broken screws with diameter range ≤ 6.5mm
Crown drill 8
(bone drill for broken screws with diameter range ≤ 8mm
Crown drill 10
(bone drill for broken screws with diameter range ≤ 10mm
Crown drill 12
(bone drill for broken screws with diameter range ≤ 12mm
Conical Extractor, female, left hand, 3
(left hand driving, for broken screws with diameter range ≤ 3mm)
Conical Extractor, female, left hand, 4
(left hand driving, for broken screws with diameter range ≤ 4mm)
Conical Extractor, female, left hand, 5
(left hand driving, for broken screws with diameter range ≤ 5mm)
Conical Extractor, female, left hand, 6.3
(left hand driving, for broken screws with diameter range ≤ 6.3mm)
Teardrop Handle, AO-Medium, cannulated
(including rotation rod)
Spreading Screwdriver Bit 5mm
Spreading Screwdriver Bit 6.3mm
Spreading Screwdriver Bit 8mm
Punches 2.7mm
Punches 3.7mm
Punches 5mm
Forceps, (small)
Forceps, (large)
Conical Extraction Rod 6mm
Conical Extraction Rod 8mm
Conical Extraction Rod 10mm
Conical Extraction Rod 13mm
Extraction Hook, (small)
Extraction Hook, (large)
Extraction Instrument Lag Screw
Nut
Threaded Rod M7
Threaded Rod M5
Threaded Rod M4
Spanner SW17
Connector, Gamma
Connector, Gamma U-Blade
Connector, Gamma3 U-Blade
Connector, Dyax
Connector, Gamma3
Connector, Omega and Omega Plus
Connector, OHS/OCS
Stryker Systems
n/a
n/a
n/a
n/a
n/a
- ISO 2.7mm screws, Ulna locking screws
- T2, S2 4mm locking screws, Grosse & Kempf 3.7mm locking screws
- ISO screws
- 3.5mm and 4.0mm, Alta 3.7mm locking screws
- 5mm locking screws (T2, S2, Gamma3, IC, Alta etc.)
- ISO screws 4.5
- 6.28mm locking screws
For AO-medium bits:
- Spreading screwdriver
- 6.28mm locking screws
- AsnisIII 6.5mm and 8.0mm
- T2, S2 Recon lag screws
- T2, S2 condyle screws
- Grosse & Kempf, SCN condyle screws
- Gamma3 end cap
- For broken screws with diameter range ≤ 3mm
- For broken screws with diameter range from 3–4mm
- For broken screws with diameter range >4mm
- For damaged screws, broken screws with diameter <9mm
- For damaged screws, broken screws with diameter >9mm
Extraction of nails using proximal nail end:
- T2 humeral
Extraction of nails using proximal nail end:
- Humerus Seidel, T2 proximal humeral, T2 humeral,
- Alta humeral, TLN (M7), SCN (M8), Alta femoral & tibial, Zickel,
- IC femoral & tibial, T2, S2 tibial & femoral antegrade/retrograde
Extraction of nails for the proximal nail end:
- All G/K nails (Fem, Tib, SFN, STN, SCN)
Extraction of nails using proximal nail end:
- Gamma3
- Gamma, Dyax, Gamma APJ
Extraction of cannulated nails with inner diameter 4.6-5.5mm:
G&K, Gamma3 (Ti), Seidel, IC, SCN, TLN, T2/S2
Extraction of cannulated nails with inner diameter =>5.6mm:
Gamma, Gamma3 (StSt), Dyax, Dyax-A, AP, AP-J, G&K, IC, SCN,
Kuentscher Nails
- Consisting of handle and extraction rod
- To be used with the threaded rod and nut for the lag screw extraction
- Fastens the extraction rod to the threaded rods and connectors
- Threaded into lag screw (Gamma/Dyax-A), fastens connection between
extraction rod and connectors
- Threaded into lag screw (Omega), fastens connection between
extraction rod and connectors
- Threaded into lag screw (OHS/OCS), fastens connection between
extraction rod and connectors
- Serves for larger torque transmission of the extraction instrument
lag screw
- Fits onto the specific lag screws, over the threaded rod and connects
with the extraction instrument lag screw
Caution: Implants can be subject to change. This can impact the compatibility of extraction instruments. It is therefore required to start the implant
extraction with a complete extraction set in order to have access to alternative instruments.
5
Screws
Implant Extraction Set
Screws
After identifying screw type and
diameter, extract the screws with
the appropriate screwdriver bit by
turning the screwdriver counterclockwise.
Screws with reverse cutting flutes
(e.g. AsnisIII screws, T2 Recon
lag screws) can be removed
using the spreading screwdriver
bits and cannulated handle.
Screwdriver Bits (hex)
To avoid damaging the screw, make
sure the screwdriver is in line with
the screw axis and fully inserted.
Screwdriver Bits (torx)
Solid Teardrop Handle
For condyle screw removal, assemble
the necessary screwdrivers:
The 6.3mm hex screwdriver bit
with the solid teardrop handle
(for the nut) and the 6.3mm hex
spreading Screwdriver bit with
the cannulated teardrop handle
(in combination with the rotation
rod) as shown in the illustration.
Screwdriver Bit
Solid Teardrop Handle
Spreading Screwdriver Bit
Teardrop Handle (cannulated)
Rotation
Rod
6
For spreading screwdriver
instructions see condyle
screw removal below.
Stryker offers a wide variety of hex
(standard, conical, spreading,)
and torx screwdrivers. Check the
available type and size on the
ordering information page.
Make sure to tighten the
rotation rod until the tip of the
screwdriver spreads firmly and
fully into the screw head.
A screwdriver needs to be inserted
from each side of the condyle screw
using one to stabilize the nut and
the spreading screwdriver to loosen
and extract the condyle screw.
If necessary, use the spreading
screwdriver to remove the nut in a
second step.
The condyle screw is extracted by
turning the screwdriver in a counterclockwise direction.
Never use a worn or damaged
screwdriver to remove screws. Reverse
cutting flutes are present for this
reason. It is recommended that the
solid screwdriver be used for screw
removal. The solid screwdriver applies
greater torque and may reduce the
potential for damaging the hexagonal
tip on the screwdriver. Strong bone
formation around the implant is
possible in the pediatric cases using
partially threaded screws. This may
lead to difficult implant removal
with an increased risk of screw
head breakage or stripping of screw
hexagonal head.
Solid Teardrop Handle
Spreading Screwdriver Bit Screwdriver Bits (hex)
Teardrop Handle (cannulated)
Rotation Rod
If the oblique direction of the screw
(approximately 135° to the shaft) is
not changed, then the reverse flutes
are not in an optimal position to
cut the cortex. If the screw head
is placed under traction and the
angle of the screw is brought to a
perpendicular position relative to the
bone, cutting the cortex will progress
and facilitate screw removal.
Be sure to use the solid screwdriver
in combination with the appropriate
sized screwdriver bits or the
cannulated screwdriver with the
spreading screwdriver bits.
Proceed as described above.
Damaged Screw Head
Screw stripping is commonly caused
by slippage of a screwdriver that is not
correctly aligned with the screw axis
and/or fully seated. This may occur either
during insertion or, more commonly,
during attempted screw removal.
The appropriate sized conical
extractor (based on the size of the
screw head hex/torx) is inserted
firmly into the screw head.
Conical Extractor (male)
Solid Teardrop Handle
Forceps for Screw
Removal
Slotted Hammer
Lightly tapping the conical extractor
with a slotted hammer may be tried if
purchase is not initially obtained with
manual pressure. It is at the surgeon's
discretion if and how hard to use the
hammer.
Assemble the selected conical
extractor (male) with the teardrophandle and turn it counter-clockwise
while applying pressure in line with
the screw axis, extracting the screw at
the same time. If the screw does not
come completely out, the forceps can
be used to complete the extraction.
7
Screws
Implant Extraction Set
Technical Details
Screws
Plates
To remove any plate, first extract
all screws by using the appropriate
size Screwdriver Bits. Remove the
plate by using a regular forceps.
The development of locking plate
technology has led to “cold welding” of
screws to the plates. In this case, cutting
tools for metal have to be used for the
removal of the screws. In order to help
protect the soft tissue from excessive
heat and metal debris accumulation,
irrigation and suction should be used
in combination with cutting tools.
Warning:
If screws are cold welded to
the plate, carbide drills may
be required. The extraction set
does not feature carbide drills
or any other instruments to
remove cold welded screws.
Solid Teardrop
Handle
Crowndrill
(Trephine)
Screwdriver Bit
Solid Teardrop
Handle
Forceps
8
Implant Extraction Set
Broken Screws
In case of a broken screw shaft:
Step 1: Remove the screw head
portion in order to gain access to
the remaining part of the screw
shaft. The screw head can be
removed with the appropriate
screwdriver as described on page 6.
Step 2: Use the drift punch to extract
the remaining part of the screw.
If difficulties are encountered with
the above process, overdrill the
remaining part of the screw with
a crown drill before proceeding
with the drift punch.
In case of a torn- off screw head:
Alternatively, the optional
countersink (6mm or 8mm)
can be used to create a path
for the crown drill.
Step 1: Overdrill the remaining
part of the screw with a crown
drill. Use another crown drill, one
size larger, in order to create space
for the female conical extractor/
drift punch. It may be necessary
to start with light pressure on the
crown drill in order to avoid the
drill walking on the cortex surface
before applying additional pressure
to penetrate the bone. Light
tapping with the slotted hammer
may be required. It remains at the
surgeon's own discretion if and how
hard to use the slotted hammer.
Step 2: Remove the remaining part
of the screw with the conical
extractor, (female) if the screw
is broken close to the first
cortex or with the help of a drift
punch if the screw is broken
close to the second cortex.
This procedure can also be
applied to broken intramedullary
nail locking screws.
Screwdriver Bit
Drift Punches
Slotted Hammer
Crown drill (Trephine)
Conical Extractor
(female)
Forceps for
Screw Removal
Solid Teardrop
Handle
Broken screw shaft - Step 1
Broken screw shaft - Step 2
Torn-off screw head - Step 2
Torn-off screw head - Step 1
9
Screws
Implant Extraction Set
Broken Cannulated Screws
To remove the torn-off head:
If steps 1 and 2 are unsuccessful
for screw removal:
Step 1: Select the appropriate
spreading screwdriver bit. Attach
cannulated teardrop handle. Insert
rotation rod through the top of the
teardrop handle. Insert tip into the
screw head and turn rotation rod to
engage and remove screw head.
To remove remaining screw body (parts):
Step 3: Overdrill the shaft
using the crown drill.
Step 4: Use a conical extractor
(female) for screw removal.
Spreading Screwdriver Bit
Step 2: Insert the conical extractor
(male) and extract the remaining screw
body turning the conical extractor
in a counter-clockwise fashion.
Crown drill (Trephine)
If the attempt for screw removal is
not successful, follow the standard
procedure for broken screw
removal described on page 8.
Conical Extractor (male) Conical Extractor (female)
Rotation Rod
Teardrop Handle
(cannulated)
Cannulated Screw Removal - Method A - Step 1
Cannulated Screw Removal - Method A - Step 2
Cannulated Screw Removal - Method B - Step 1
Cannulated Screw Removal - Method B - Step 2
10
Lag Screw
Implant Extraction Set
Lag Screw
Make a small incision through
the old scar distal to the greater
trochanter to expose the outer end
of the lag screw.
An incision is made over the proximal
end of the nail. The end cap, if used, is removed using the appropriate
screwdriver bit followed by removal
of the set screw using the 4.0mm
screwdriver as shown in the image
below 1 .
Screwdriver Bit Hex 3.5mm
The threaded rod is then attached
and tightened into the lateral,
exposed end of the lag screw 2 .
Threaded Rod
For Gamma implants: position the
K-wire through the lag screw.
Solid Teardrop Handle
The threaded rod is inserted over
the K-wire (when used for Gamma)
and tightened into the lateral,
exposed end of the lag screw.
Remove the K-wire, if used.
1
2
11
Implant Extraction Set
Lag Screw (continued)
Connector
Threaded Rod
Lag Screw
Extraction Rod and Nut
Wrench 8/10mm, standard
Check that ingrowth does not obstruct
secure engagement of the extraction
device, otherwise the implant or the
instrument may be damaged and
extraction will be more difficult.
Slide the appropriate connector over
the threaded rod before adding the
extraction rod & nut as shown in the
picture 3 .
Note:
The Gamma3 lag screw was selected
as an example to demonstrate lag
screw removal.
3
However, different connectors
are available for other implants
including a lag screw. See details on
the ordering information page.
4
Finish assembly of the lag screw
extraction device by tightening the nut
4 and attaching the T-handle 5 in a
final step as shown in the picture.
Handle
Spanner 17mm standard
5
6
12
The lag screw is extracted by counterclockwise rotation and pulling 6 .
Use the 7mm spanner wrench if higher
forces are required for the removal of
the lag screw.
Implant Extraction Set
Intramedullary Nails
Caution:
Special care must be taken to check
if the nail moves off-center from the
entry point when screws are removed.
Any attempt to remove a nail that
is off-center may result in fractures
of the distal condylar region.
Conical Extraction Rod
Universal Rod
Strike Plate
The end cap, if used, is removed using
a screwdriver. If bone ingrowth
obstructs access to the nail,
use of either a crown drill, pick
(not supplied), or curette (not
supplied) may provide access.
Sliding Hammer
Slotted Hammer
Universal Rod
Sliding Hammer
or use the
Slotted Hammer
Remove the distal/proximal screw with
the appropriate screwdriver bit. Do
not take out the screws of the driving
(proximal) end until the conical
extraction rod is attached to the top
of the nail in order to avoid rotation.
Insert the conical extraction rod
into the driving end of the nail.
Lightly hammer the conical extractor
in order to fully engage the cutting
flutes.
Connect the strike plate and the
universal rod either adding the sliding or
slotted hammer as shown in the picture.
Strike Plate
Remove the remaining locking screws
and confirm with fluoroscopy that
locking screws have been removed
before using either hammer to remove
the nail.
Conical
Extraction Rod
Step 1
Step 2
13
Nails
When removing an Intramedullary
nail, it is helpful to identify the nail
brand and its diameter in order to
choose the correct instrumentation.
Implant Extraction Set
Broken Intramedullary Nails
Removal of broken intramedullary
nails may be particularly challenging.
Stryker developed a system that can
be used for the removal of many
cannulated intramedullary nails.
An incision is made over the proximal
end of the nail. The end cap, if used,
is removed using a screwdriver. If
bone ingrowth obstructs the access
to the nail, the use of either a chisel/pick (not provided) or a crown
drill will facilitate removal.
Conical Extraction Rod
Universal Rod
Remove the distal screw with the
appropriate screwdriver bit. Do
not take out the proximal screws
until you have attached the conical
extraction rod to the top of the
nail in order to avoid rotation.
Sliding Hammer
Connect the universal rod and the
strike plate to the extraction rod
(center of page) either adding the
sliding or the slotted hammer.
Strike Plate
Extraction Hook
Step 1: Insert the nail extraction
device into the proximal end of the
nail, tightening it as firm as possible.
Universal Rod
Nails
Sliding Hammer
Step 2: Remove the proximal screws
before using either hammer
to remove the nail.
Step 3: After removal of the proximal
nail end, exchange the conical extraction
rod for the extraction hook (as shown
to the left). Insert extraction hook into
the cannulation of the nail fragment.
Under fluoroscopy, verify that the
hook has passed through the nail end.
Make sure that the hook takes
a hold at the end of the nail
before pulling to remove it.
Strike Plate
Step 4: Use the sliding or the
slotted hammer to pull out the
remaining part of the nail.
Extraction Hook
Broken Intramedullary Nails - Step 1
Broken Intramedullary Nails - Step 2
14
Broken Intramedullary Nails - Step 3
Broken Intramedullary Nails - Step 4
Notes
15
Manufactured by:
Stryker Trauma GmbH
Prof.-Küntscher-Straße 1–5
D - 24232 Schönkirchen, Germany
0123
This document is intended solely for the use of healthcare professionals. A surgeon must always rely on his or her
own professional clinical judgment when deciding whether to use a particular product when treating a particular
patient. Stryker does not dispense medical advice and recommends that surgeons be trained in the use of any
particular product before using it in surgery.
The information presented is intended to demonstrate a Stryker product. A surgeon must always refer to the
package insert, product label and/or instructions for use, including the instructions for Cleaning and Sterilization
(if applicable), before using any Stryker product. Products may not be available in all markets because product
availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Stryker
representative if you have questions about the availability of Stryker products in your area.
Stryker Corporation or its divisions or other corporate affiliated entities own, use or have applied for the following
trademarks or service marks: Stryker. All other trademarks are trademarks of their respective owners or holders.
The above listed products are CE marked.
Content ID: IES-ST-1 Rev. 2 , 06-2015 (Former Literature Number: B1000057 & LIES-OT)
Copyright © 2015 Stryker
www.stryker.com